Article

OBJECTIVE: To assess the diagnostic accuracy of history taking and physical
examination for assessing anterior cruciate ligament (ACL) lesions in primary
care. DESIGN: Cross-sectional diagnostic study. SETTING: Primary care.
PARTICIPANTS: Patients (N=134; age, 18-65y) who consulted their general
practitioner (GP) within 5 weeks after injury. INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Index tests were obtained with a questionnaire and
physical examination. Magnetic resonance imaging (MRI) was used as the reference
test. Logistic regression analysis was used to determine associations with ACL
lesions. Diagnostic accuracy was determined by calculating sensitivity (Se),
specificity (Sp), predictive values, and likelihood ratio (LR). RESULTS: MRI
showed an ACL lesion in 28 of 134 included patients. "Effusion," "popping
sensation," "giving way," and "anterior drawer test (ADT)" showed associations
with an ACL lesion (P<.05). Popping sensation showed Se, Sp, positive predictive
value (PPV), and positive LR (LR(+)) of .63, .73, .39, and 2.3, respectively.
Combining determinants from history taking (2 of 3 positive results regarding
effusion, popping sensation, and giving way) improved diagnostic accuracy (Se,
.71; Sp, .71; PPV, .42; and LR(+), 2.5). The ADT added diagnostic accuracy to
these combinations (Se, .63; Sp, .85; PPV, .52; and LR(+), 4.2). CONCLUSIONS: ACL
lesions are seen frequently. Based on history taking (effusion, popping
sensation, and/or giving way) and physical examination (ADT), GPs can screen for
ACL lesions in primary care.

Langue : ANGLAIS